Department of Nephrology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
Ultrastructural Pathology Laboratory, "Victor Babes" National Institute of Pathology, Bucharest, Romania.
Ultrastruct Pathol. 2023 Nov 2;47(6):461-469. doi: 10.1080/01913123.2023.2256836. Epub 2023 Sep 12.
This retrospective, cross-sectional study sought to examine the ultrastructural characteristics of glomerular lesions using Transmission Electron Microscopy (TEM) in IgA nephropathy (IgAN) and their relationship with the high risk of progression phenotype defined by KDIGO guideline as proteinuria ≥1 g/24 hours despite 3 months of optimized supportive care. We analyzed 81 IgAN patients (median age 41 years, 67% male, eGFR 43.8 mL/min, proteinuria 1.04 g/day); 42 (52%) of them had high risk of progression. There were no differences in terms of age, sex, comorbidities, eGFR, and hematuria between the two groups. High-risk patients more often had segmental glomerulosclerosis (29% vs 8%, p 0.01) in optical microscopy, while in TEM had more frequent podocyte hypertrophy (62% vs 26%, p 0.001) and podocyte foot process detachment from the glomerular basement membrane (19% vs 8%, p 0.05), more often thicker (19% vs 5%, p 0.05) and duplicated (26% vs 10%, p 0.05) glomerular basement membrane, and the presence of subendothelial and subepithelial deposits (31% vs 13%, p 0.05). However, in multivariate binary logistic regression analysis, only podocyte hypertrophy (OR 3.14; 95%CI 1.12, 8.79) was an independent risk factor for high-risk progression in IgAN. These findings highlight the importance of podocytopathy in IgAN progression.
本回顾性、横断面研究旨在通过透射电子显微镜（TEM）检查 IgA 肾病（IgAN）肾小球病变的超微结构特征及其与 KDIGO 指南定义的高进展风险表型的关系，该表型为尽管经过 3 个月的优化支持治疗，但蛋白尿仍≥1g/24 小时。我们分析了 81 例 IgAN 患者（中位年龄 41 岁，67%为男性，eGFR 43.8mL/min，蛋白尿 1.04g/天）；其中 42 例（52%）有高进展风险。两组在年龄、性别、合并症、eGFR 和血尿方面无差异。高风险患者在光学显微镜下更常出现节段性肾小球硬化（29%比 8%，p<0.01），而在 TEM 下更常出现足细胞肥大（62%比 26%，p<0.001）和足细胞足突从肾小球基底膜分离（19%比 8%，p<0.05），更常出现更厚的（19%比 5%，p<0.05）和重复的（26%比 10%，p<0.05）肾小球基底膜，以及存在内皮下和上皮下沉积物（31%比 13%，p<0.05）。然而，在多变量二项逻辑回归分析中，只有足细胞肥大（OR 3.14；95%CI 1.12, 8.79）是 IgAN 高进展风险的独立危险因素。这些发现强调了足细胞病变在 IgAN 进展中的重要性。
